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2098253893 ENGINEERING DEPT. 0005 a.m. 09-10-2010 14/21 <br /> Designated Und ground Storage Tank (UST) Operator <br /> Monthly Visual Inspection Checklist <br /> Facility Name: Kaiser Permanente Manteca Date: 07/22/2010 <br /> Facility Address: 1777 W.Yosemite <br /> City: Manteca Zip Code: 95337 <br /> DesignatedUST Operator Conducting the Inspection; Thomas Hin Ston II <br /> International Code Council Certification#: 530106J-UC Expiration Dater 12/12/2010 <br /> Si ature:Thomas Hin stop 11 Phone: 70 295-6066 <br /> R Y=Yes,N=No NA=Not A licable <br /> Item MONITORING PANEL/ALARM HISTORY Y N NA <br /> 1 Monitoring stem is powered on and in proper operating mode. X <br /> 2 Monitoring system is not currently showing LnX alarms or warnings. X <br /> 3 Alarm history report/lpg for the previous month is available,and has been reviewed by the <br /> Designated UST Opejator. Attach a copy of the alarm history report/logreporillog to this orm if available. X <br /> 4 Each alarm for the plevious month has been res onded to appropriately. <br /> X <br /> 5 Sensors located in tank-top containment sums have not alarmed in the past month. X <br /> 5a _ List all tank-top sumps where alarms occurred in the past month: <br /> Note:Sumps where an alarm has occurred in the past month must be inspected unless a qualified service technician responded to,and <br /> properly addressed,the cause of the alarm.Attach documentation verging appropriate service to this report. <br /> I sum i ection is re uired,record results in item 6,below. <br /> h UST SYSTEM INSPECTION <br /> 6 Tank-top containment sumps are free of water,debris,and hazardous substance. Sensors are located properly. <br /> Note:Yisual inspection of sums is only required in sum s where an alarm has occurred in theeast month or which there is no service record. <br /> Y I N Y N <br /> Suino Location: Sump Location <br /> Sump Location: Sum Location: <br /> t <br /> Sump Location: ::—BSump Location: <br /> 7 Spill containment structures are free of water,debris and hazardous substance. <br /> Y I N INAI I Y N INA <br /> Tank 1—Contents: Diesel X Tank 3—Contents: <br /> Tank 2—Contents: Tank 4--Contents: <br /> 8 o dispensers are utilized at this facility FX <br /> PAPERWORK INSPECTION Y N NA DATE DONE <br /> FI <br /> Monitorin stem certification has been completed within past 12 months. X 08/01/09 <br /> Secon containment tests have been com leted within the re uired timeframe.* X 08/11/09 <br /> S ill containment structure bucket testin was com leted within the ast ear. X 08/01/09 <br /> Tank tightness testin was com leted within re uired timeframe. X <br /> Line tightness testing was completed within required timeframe.* X 08/29/08 <br /> 14 1 Other required t stip /maintenance was completed within required timeframe. List test/maintenance items below. <br /> Test/Mainta e: <br /> TestlMaintenance:. <br /> Test/Maintenance: <br /> rFACILITY EMPLOYEE TRAINING Y N NA <br /> 15 All facility employees have received the required on-the-'ob training within the past year.12/11/2009 X _ <br /> 16 All facili em to ees hired within the past 30 da s have received the re uired on-the-'ob training. X <br /> Note: Any answer¢f"N"should be explained in the comment section,and will require follow-up action. <br /> Comments: No alarm history print out available.Owner(KCS PM)advises facility working with county to obtain <br /> permit for piping,installation will advise status upon resolution.*Owner to schedule line test upon resolution with <br /> county.*Owner should notify County re UST status and inquire whether SB989 testing should be performed. <br /> Follow up Actions: <br /> e <br /> Page I of 1 November 2004 <br /> 0.` <br />